New Approach Brings Medical Students Closer to Patients

Jan 6, 2016

Medical student Amanda FormosaMedical student Amanda Formosa In third year, medical students make their foray into clinical settings. As part of their clerkship, they work with physicians in emergency rooms, surgical wards, and other clinical areas. Until recently, students at U of T did these clerkships one specialty at a time, but a new approach—called the Longitudinal Integrated Clerkship (LInC)—is changing that. Their weekly schedule includes a variety of different specialties, which they continue with for the entire year. They remain with the same experienced physicians who supervise their work and get to see the same patients over time. Amanda Formosa is a fourth-year medical student who opted for the LInC program at St. Michael’s Hospital the first year it was offered. She shared the ups and downs with Faculty of Medicine writer Carolyn Morris.

Q:  What did you like the most about the LInC program?

Having a panel of patients to follow over time was great, because we could see the same patient go through different stages of an illness. It’s a great learning experience because you can form a relationship with the patient and you can see how their story develops over time. For example, I got to know one patient who needed surgery. I learned about the anxiety and stress she suffered because of her condition, got to be there for the surgery and also helped when she had some concerns weeks after the operation. I got a real sense of the responsibility and satisfaction that comes with treating patients.

Your patients are the stars of the show. You’re going to learn whether you’re in a block clerkship or a longitudinal clerkship, but LInC gives you that opportunity to connect with patients and understand them. And you get to understand not only their medical problems but even their social issues and how their lives change over time. It’s a big lesson to learn and it’s really an honour to be part of it.

Q:  You also get to work with the same supervisors over time. What was that like?

When I heard that with the LInC program you would know someone over the entire year, I thought it was a great idea. With the LInC program, the physicians can see you grow over time. It’s a really good opportunity for someone to get to know you and see how you respond to feedback and develop over time.

Q:  What is “white space” and what did you do with it?

“White space” is time that’s carved out of our schedule for us to pursue specialties we’re interested in. The great thing about it is you have this passport to any learning you want to do. If I felt I didn’t understand an area enough, I would try to learn more during my white space. For example, I could message my emergency medicine supervisor and ask if I could come in for a shift, or I could spend an extra day on the in-patient cardiology ward. I went to neurosurgery clinic for two days, and I did an extra half day in pediatric hematology because I didn’t feel very comfortable with the subject matter. In all clerkships you can do this type of self-directed learning, but with LInC it was expected of you. It was encouraged, so you felt more comfortable doing it.

Q: What were the challenges of LInC – were there any downsides?

Especially in the beginning it was really hard to be switching from one specialty to the next within the same week. You’re doing one day of family medicine, one day of pediatrics, one day of surgery and so on. But what happens over a few months is you learn things in one specialty that applies to another. The learning becomes integrated and it starts to make a lot of sense.

Q: Overall, are you glad you opted for the LInC program?

Definitely. We were the pilot year, and seven of us applied. We took a risk in doing this clerkship because it was the first time it was going to be done here. But it was a calculated risk. It’s been done before at Harvard University and other universities. It was well researched before being proposed at St. Mike’s. And we had a great team of people taking care of us.


The University of Toronto will be hosting the next international gathering of the Consortium of Longitudinal Integrated Clerkships (CLIC) in the fall of 2016.



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